Impacts of prescription drug monitoring program policy changes and county opioid safety coalitions on prescribing and overdose outcomes in California, 2015–2018

• Published in: Preventive medicine 2021-12, Vol.153, p.106861-106861, Article 106861
• Main Authors: Henry, Stephen G., Shev, Aaron B., Crow, David, Stewart, Susan L., Wintemute, Garen J., Fenlon, Christine, Wirtz, Stephen J.
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - therapeutic use; Drug Overdose - drug therapy; Drug Overdose - prevention & control; Health care coalitions; Humans; Opioid analgesics; Opioid overdose; Policy; Practice Patterns, Physicians; Prescription Drug Monitoring Programs; Program evaluation
• ISSN: 0091-7435; 1096-0260
• DOI: 10.1016/j.ypmed.2021.106861

In 2015, California received funding to implement the Prescription Drug Overdose Prevention Initiative, a 4-year program to reduce deaths involving prescription opioids by 1) leveraging improvements to California's prescription drug monitoring program (PDMP) (i.e., mandatory PDMP registration for prescribers and pharmacists), and 2) supporting county opioid safety coalitions. We used statewide data from 2011 to 2018 to evaluate the Initiative's impact on opioid prescribing and overdose rates. Prescribing data were obtained from California's PDMP; fatal and non-fatal overdose data were obtained from the California Department of Public Health. Outcomes were monthly opioid prescribing rates and opioid overdose rates, modeled using generalized linear mixed models. Exposures were mandatory PDMP registration, presence of county coalitions, and Initiative support for county coalitions. Mandatory PDMP registration was associated with a 25% decrease (95%CI, 0.71–0.79) in opioid prescribing rates after 24 months. Having a county coalition was associated with a 2% decrease (95%CI, 0.96–0.99) in the opioid prescribing rate; receiving Initiative support was associated with an additional 2% decrease (95%CI, 0.97–0.98). Mandatory PDMP registration and county coalitions were associated with a 35% decrease (95%CI, 0.43–0.97) and a 21% decrease (95% CI, 0.70–0.90), respectively in prescription opioid overdose deaths. Both interventions were also associated with significantly fewer deaths involving any opioid but had no significant association with non-fatal overdose rates. Findings add to the knowledge available to guide policy to prevent high-risk prescribing and opioid overdoses. While further study is needed, coalitions and mandatory PDMP registration may be important components in such efforts. •Mandatory PDMP registration was associated with fewer overall & high-dose opioid prescriptions.•County opioid safety coalitions were associated with fewer overall opioid prescriptions.•Both interventions were associated with fewer fatal opioid overdoses (prescription & any opioid).•Neither intervention was associated with changes in non-fatal opioid overdose rates.